age specific  Step by Step  developmental information sheets directly to members.

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Conducting the telephone member survey led to the creation of the Provider

Training Guide and to the addition of questions relevant to child development ser 

vices to CommunityCARE's member satisfaction survey.  

Home Visits

If children and their parents or caregivers are not able to visit a provider's office, pub 

lic health nurses, social workers, and other trained home visitors can deliver child

development services through home visits. For example, a trained home visitor could

administer a developmental screening, provide parent education and counseling, and

identify local community resources for families.  A home visit may be required when

parents are unable or unwilling to keep appointments because of work schedule con 

flicts, cultural or linguistic factors, lack of transportation, or other challenges faced by

many low income families.  Two of the workgroup

members, Network Health of Massachusetts and

 Parents are usually more relaxed at

Managed Health Services of Wisconsin, piloted varia 

home, and visitors can see things in

tions of home visit approaches with their member pop 

homes that pediatricians can't see in

ulations. 

the office. 

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 Albert Yee, MD, of Network Health

Network Health and the Visiting Nurse Association

Network Health's overall aim was to improve screening

for children between six and 18 months of age. The plan targeted its third largest

pediatric practice to implement the ASQ. Network Health partnered with the

Visiting Nurse Association (VNA) to conduct the ASQ screening tool during home

visits with children who were not reached at the pilot provider site. The following

criteria were developed to stratify at risk children at 10 months of age targeted by the

VNA:

Low birthweight infants not receiving other services.

Infants for whom VNA has reported concerns.

Mother with reported psychiatric history that may cause concern for developmen 

tal delays due to lack of attention.

Maternal history of postpartum depression.

Maternal learning disabilities.

Infants identified as failure to thrive.

Teenage moms under 18 who have not accepted case management.

During the pilot phase, 299 children were identified as eligible for the program, of

whom 73 percent were reached by family service workers.  Forty one percent of eligi 

ble children were screened using ASQ (57 children were screened at home; 32 addi 

tional children were screened at an office visit).  Ten children were referred to early

intervention based on ASQ screening. A subsequent provider and member survey

indicated that 60 percent of physicians in the practice found ASQ helpful in focus 

ing conversations with the family; 80 percent found it helpful to identify children in

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Samples of CommunityCARE's members mailings sheets are available in the online toolkit at www.chcs.org.

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The Commonwealth Fund Quarterly. Summer 2003 Vol 9, Issue 2.

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